Opioid Prescription Practices Among Orthopedic Surgeons: An Analysis of the Medicare Part D Database from 2013-2021

Introduction Orthopedic surgeons have historically been identified as one of the most frequent prescribing specialties for opioid medications. Although there are indications for the short-term use of opioids post-operatively, efforts have been made through legislature, hospital protocols, and advanced techniques, to reduce the length of time for which opioid analgesics are required. Methods The Medicare Part D Database (individuals 65+ years old) was queried for prescriptions made by orthopedic surgeons for the years 2013-2021. Variables of interest included total claims, number of beneficiaries, and prescription length. The top ten opioids were identified using the total claims for each opioid. The South, Northeast, West, and Midwest regions of the United States were used as defined by the US Census Bureau. Linear regression was used to determine changes in claims and prescription length over time. Z-test of proportions was used to compare changes in beneficiaries. All statistical analyses were performed using R Studio (4.2.3), with p<0.05 indicating statistical significance. Results In 2021, Alabama and Alaska had the highest and lowest number of total claims and claims per surgeon for the top 10 opioids, respectively. Regional analyses demonstrated the Northeast region had the largest percent decrease (-33.84%), while the South had the highest number of total claims, claims per surgeon, and beneficiaries per 10,000 people. Hydromorphone demonstrated the largest decrease in prescription length (-35.96%, p <0.001) while Oxymorphone had the largest increase (10.29%, p<0.001). Finally, Oxymorphone had the greatest percent reduction in total claims (-92.51%, p<0.001) over the study period. Conclusion There has been a significant reduction in opioid prescriptions by orthopedic surgeons from 2013-2021, however, certain regions, such as the South, still have relatively high prescription lengths and number of prescriptions for opioid analgesics. Further, studies should seek to identify the specific factors influencing reduced opioid prescriptions to implement these in regions in which further reductions may be necessary.